All medicines were poisons in one form or another, merely diluted to an appropriate dose. But chemotherapy was poison even at the correct dose.

Part Two opens by introducing Mary Lasker, another key player in cancer’s history. Married to advertising titan Albert Lasker, Mary had adopted philanthropy as her vocation.

Lasker had suffered several close brushes with disease in her past, including the deadly Spanish flu pandemic, life experiences which eventually led her to focus on medical research as her primary philanthropic cause. Working in partnership with Farber, Lasker’s formidable fundraising skills and political connections had an even greater impact on cancer research than Farber’s initial efforts for his children’s cancer research fund.


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All medicines were poisons in one form or another, merely diluted to an appropriate dose. But chemotherapy was poison even at the correct dose.

Part Two opens by introducing Mary Lasker, another key player in cancer’s history. Married to advertising titan Albert Lasker, Mary had adopted philanthropy as her vocation.

Lasker had suffered several close brushes with disease in her past, including the deadly Spanish flu pandemic, life experiences which eventually led her to focus on medical research as her primary philanthropic cause. Working in partnership with Farber, Lasker’s formidable fundraising skills and political connections had an even greater impact on cancer research than Farber’s initial efforts for his children’s cancer research fund.

In 1943, Mary Lasker visited the American Society for the Control of Cancer (ASCC) only to conclude the doctors in charge lacked essential fundraising knowledge. Mary and Albert Lasker, on the other hand, understood it very well. Using one of her established contacts, Mary Lasker convinced Reader’s Digest to run an article on cancer that generated more donations for research than the totality of ASCC’s annual budget.

The ASCC became the American Cancer Society (ACS), with advertising and fundraising its new priorities under the Laskers’ direction. In creating the Society’s Board, the Laskers handpicked businessmen, advertisers and other non-medical professionals to hold positions. In addition, the Laskers ruled that scientists and doctors could only occupy a total of four posts on the board, thereby minimizing doctors’ influence and assigning most influence and power to those individuals savvy to the world of marketing and fundraising.

In 1948, the director of the National Cancer Institute introduced Dr. Farber to Mary Lasker. Farber’s vision of killing cancer chemically intrigued Lasker, an intellectual attraction which led to the two becoming regular correspondents, friends, and partners. After Mary Lasker’s husband died of colon cancer in 1952, she became even more of a crusader for the cause.

Lasker and Farber sought to redesign cancer research, focusing their research for a cure in the way the Manhattan Project focused on principles of physics while building a nuclear bomb. This new approach ran contrary to science’s emphasis on basic research as the first step toward applied results and their approach was not without its critics.

At the time, however, the “Laskerites” had the upper hand. According to them and their supporters, waiting for basic research in the face of the threat of cancer was a waste of time. In 1954, the government directed the National Cancer Institute to create a program for developing chemotherapy drugs. Mukherjee’s analysis of their approach is often emphasized in later chapters: Until late in the 20th century, cancer treatment was based on trial and error, rather than an established knowledge of cancer biology.

Meanwhile, Farber’s fundraising work didn’t slow down his research. He continued testing increasingly powerful and dangerous drugs on patients. If one treatment didn’t work, Farber switched to a new drug. Despite the risks, Farber made significant gains. Combining X-rays with the drug actinomycin D, for instance, allowed oncologists to use chemotherapy against solid tumors for the first time.

Not all research breakthroughs were in the form of new drugs. In 1955, for instance, NCI Director George Zubrod made a major change in how the institute tested drugs. In the 1940s, scientists had developed a new approach to clinical trials, randomizing them so that doctors were unable to distinguish which patients were receiving the drug and which were receiving just a placebo. Zubrod then adopted this same randomized sample method for chemotherapy research.

Zubrod and NCI oncologists Emil Frei and Emil Freirich tested combinations of drugs in the hope that just as doctors occasionally utilized multiple antibiotics to overcome drug resistance in tuberculosis cases, multiple drugs would improve remission rates in cancer.

However, even one drug was toxic to normal cells, so using combinations of multiple drugs made chemotherapy that much more hellish for patients. Frei and Freirich’s experimental medication regimens got their laboratory labeled “the butcher shop,” but in spite of the unflattering nickname, Frei and Freirich continued their research, eventually testing combinations of as many as four different drugs.

This historical example demonstrates another recurring theme in Mukherjee’s work: the term “war on cancer” is not just a metaphor. Oncologists did whatever it took to root out cancer, resorting to increasingly aggressive surgeries and increasingly aggressive drug treatments. If the patient survived, the collateral damage to patients’ bodies and lives seemed insignificant: It was war, and oncology wasn’t taking any prisoners.

Aside from toxicity, the tested multiple-drug regimen raised other problems. When using one drug, doctors had to decide how often and how much of a dose to give to treat the cancer effectively. With three or four drugs, the range of potential treatments increased exponentially. Mukherjee estimates that to test every combination for a four-drug program would take 150 years.

The toxicity of chemotherapy wiped out the career of one NCI researcher, Min Chiu Li. Li measured the effectiveness of treatment by measuring the level of hormones secreted by certain cancers. Li became convinced that even if a patient’s body showed no evidence of remaining tumors, the cancer wasn’t gone and required further chemotherapy.

The NCI board thought giving toxic chemicals to patients who appeared healthy showed terrible judgment on Li’s part. The institute fired Li, but several years later, other oncologists validated Li’s claim: To be successful, treatment often had to run long after the patient appeared to be cancer-free.

Frei and Freirich ran into almost as much controversy with a childhood leukemia treatment combining the drugs vincristine, amethopterin, mercaptopurine and prednisone, or VAMP.

The first human guinea pigs in the VAMP trials lost all their white blood cells, became vulnerable to infection and nearly died. Then they recovered, while their cancers disappeared. Even in severely ill patients, VAMP purged the cancer and brought remission. Unfortunately, in most patients, the cancer had already spread into their brains, which were protected from poisons, including chemotherapy drugs, by the blood-brain barrier. All but five percent of VAMP patients succumbed to their brain-hosted leukemia.

Another multi-drug treatment, MOPP, gave patients with Hodgkins lymphoma added years of life. The price included gut-wrenching nausea, sterility, and in some cases, the MOPP drugs proved to be carcinogenic themselves. Nevertheless, oncologists began thinking that VAMP’s problem was that it wasn’t aggressive enough: Combining six drugs or eight might finally give them the magic bullet.

Mukherjee brings readers into the field of oncology in the 1970s as the section comes to a close. For the “Laskerites,” it was a triumphant time, as the federal government pumped even more money into cancer research, turning the NCI into a veritable “NASA for cancer.”

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